The 543-word editorial that may have just upended the presidential campaign

Republicans thought they were done with their Obamacare nightmare. Then Donald Trump read a Wall Street Journal op-ed.

It was an item by the paper’s editorial board that piqued the former president’s frustration — one focused on health care industry consolidation but touching enough on the Affordable Care Act to reignite grievances about failing to repeal the law. And so, he fired off a post on Truth Social saying he was “seriously looking at alternatives” and that 2017’s failed repeal and replace effort was “a low point for the Republican Party.”

In a click of a button, a long-dormant campaign fault line was reopened.

The post lit a fire under President Joe Biden’s slow burn campaign. Significant campaign resources were quickly mobilized in response. Groups began preparing new ads calling for Obamacare’s protection. GOP lawmakers on the Hill had to take cover from inquisitive reporters asking if they backed Trump’s call. Advocacy organizations dusted off old playbooks.

"It's a story that tells itself," said Leslie Dach, the chair of Democrat-aligned group Protect Our Care. "He's opening up a Pandora's box of hurt."

The assumption among Trump advisers was that the primary reason he put out the social media missive was that he’d read that Journal editorial, which was included along with his post. But they noted health care policy had recently been top of mind — just the week before, Trump had lunch with former Kansas Gov. Jeff Colyer, a surgeon, where they talked about health care, among other things, which prompted an endorsement.

The fallout from Trump reading the Journal editorial page looms large. It didn’t just underscore how potent health care remains as a policy motivator for Democrats, but how deeply embedded the Affordable Care Act has become in the nation’s political and social fabric. It also demonstrated once again, how Trump’s impulsive social media habit remains a major variable for the coming election and how much the Republican Party’s policy portfolio can be affected by the whims and media diet of its figurehead.

Trump’s campaign is drawing up a health care proposal, although it is unclear when that will be released or if it will propose a full replacement plan (Republicans have struggled to put one together for years). The campaign is also setting up working groups that focus on specific issue areas, like health care. And Trump has released policy videos focused on “taking on Big Pharma,” ending pharmaceutical shortages, and addressing chronic childhood illnesses and drug addiction.

But in terms of another full blown repeal-and-replace proposal, one Republican close to the campaign said, "there's not a real 'there' there. No one's working on this."

The Trump campaign did not comment.

For Democrats, Trump’s renewed attacks on Obamacare amount to a political gift that some in the party said they couldn’t have timed better. The threat to “terminate” the signature health law comes amid a Biden campaign effort to highlight what Trump would do if returned to office, and portray his agenda as out of step with the vast majority of Americans.

The Biden campaign has rushed into action since Trump’s post over the holiday weekend, blasting out a series of emails centered on his remarks and scrambling a press call Tuesday where former Speaker Nancy Pelosi warned repeatedly of an “assault on the financial and health security of America’s families.”

“It’s as personal as any public issue can be,” Pelosi said, recounting her fight with Trump over his failed 2017 efforts to repeal Obamacare. “The choice simply could not be clearer.”

At a Tuesday campaign reception, Biden highlighted Trump's remarks as well, telling the crowd that "I hope you didn't miss it."

The Biden campaign plans to launch new ads later this week in swing states contrasting Biden and Trump’s health care records. On X, formerly known as Twitter, the campaign has posted or reposted about the issue over a dozen times in the last few days — including distributing clips of Trump attacking Obamacare over the past several years.

It all represents an abrupt pivot for an operation that, until now, had prioritized a range of more immediate issues — like spotlighting Biden’s legislative accomplishments and his work to revive the economy — or casting Trump as a broader threat to democracy. When Biden has mentioned health care, it’s largely been in the context of lowering drug prices.

But Obamacare is familiar territory for Democrats who have successfully run on defending the health law. Dach said Protect Our Care has a trove of material from prior Obamacare fights that's suddenly relevant again, including clips of Trump attacking the law on dozens of occasions. Over the last few days, he added, he's gotten calls from Democratic operatives around the country eager to make the issue central to their own down-ballot races.

One longtime Democratic pollster said Wednesday that Trump’s repeal-and-replace rhetoric was a welcome reminder that, for all of Biden’s difficulties, “Trump can still fuck up.”

“We can win that issue, believe me,” said the pollster who was granted anonymity to speak candidly. “Be my guest … Thank you. Keep doing it.”

Despite Trump’s assertion that he is looking at “alternatives” to Obamacare, three Republicans close to the campaign said there’s recognition that few in the party want to take another shot at Obamacare repeal, and that there are no big new ideas for how to replace a law that's now ingrained in the U.S. health system.

In a series of posts on Wednesday morning, Trump said he was not trying to “terminate” Obamacare but “replace it with much better healthcare.”

“Obamacare Sucks!!!” he added for emphasis.

But rather than a wholesale overhaul, conservative health experts in touch with the campaign have urged Trump officials to build a platform that chips away at parts of the law.

A government-wide policy planning effort by the Heritage Foundation that’s meant to be a blueprint for the next GOP administration proposes loosening a range of Obamacare rules aimed at enforcing a minimum level of benefits. Those include easing guardrails on what types of plans can be offered and developing a separate, less-regulated market for insurance that’s not eligible for government subsidies.

The proposal also encourages reviving an effort to limit federal funding for Medicaid by imposing financial caps or block grants, a top priority during Trump’s presidency that the administration was never able to implement.

“The reform has to be bigger than just Obamacare,” said Roger Severino, a former senior Trump health official who was lead author of the 54-page section outlining a range of conservative priorities across the health care landscape. “We need to reassess how we could improve the system and learn the lesson that was learned hard, that the top-down management of Obamacare didn’t work.”

Bobby Jindal, the former governor of Louisiana who recently endorsed Trump and is chair of the Center for a Healthy America at the Trump-aligned America First Policy Institute, has advocated for Republican-led state legislatures to take a number of approaches. Those include expanding on things like the Trump administration’s rules requiring price transparency for health plans and hospitals and patient-based Medicaid reforms. In Arkansas, Gov. Sarah Huckabee Sanders has called for Medicaid work requirements.

Trump allies in the meantime have pressed the campaign to take sharper rhetorical aim at Biden on health care, in an effort to erode Democrats’ advantage on the issue. Among suggestions made to officials is to link rising health costs to overall inflation, according to one of the Republicans close to the campaign.

But instead, those nuances have been lost amid what several allies saw as Trump’s overriding focus on his failure to repeal Obamacare six years ago. The GOP frontrunner still stews over the late Sen. John McCain’s decision to tank a narrow repeal measure on the Senate floor. And he is still bitter at other Republicans, like Senate Majority Leader Mitch McConnell, who convinced him to prioritize repeal early on in his presidency and rely on congressional Republicans to draw up a plan that could pass.

“He went along with them and we all saw what happened,” said one of the Republicans close to the campaign. “Trump feels burned.”